Post-disaster mental health and psychosocial support: experience from the 2015 Nepal earthquake

On 25 April 2015, an earthquake of magnitude 7.8 struck Nepal, which, along with the subsequentaftershocks, killed 8897 people, injured 22 303 and left 2.8 million homeless. Previous efforts to provideservices for mental health and psychological support (MHPSS) in humanitarian settings in Nepal have beenlargely considered inadequate and poorly coordinated. Immediately after the earthquake, the Governmentof Nepal declared a state of emergency and the health sector started to respond. The immediate responseto the earthquake was coordinated following the Inter-Agency Standing Committee (IASC) cluster approach.One month after the disaster, integrated MHPSS subclusters were initiated to coordinate the activities ofmany national and international, governmental and nongovernmental, partners. These activities were largelyconducted on an ad-hoc basis, owing to lack of focus on MHPSS in the health sector’s contingency plan foremergencies. The mental health subcluster attempted to implement a mental health response accordingto World Health Organization and IASC guidelines. The MHPSS response highlighted many strengths andweaknesses of Nepal’s mental health system. This provides an opportunity to “build back better” throughreform of mental health services. A strategic response to the lessons of the 2015 earthquake will deliver bothimproved population mental health and increased preparedness for the future

Suicide burden and prevention in Nepal: the need for a national strategy

Suicide is a major cause of deaths worldwide and is a key public health concern in Nepal. Althoughroutine national data are not collected in Nepal, the available evidence suggests that suicide ratesare relatively high, notably for women. In addition, civil conflict and the 2015 earthquake have hadsignificant contributory effects. A range of factors both facilitate suicide attempts and hinder thoseaffected from seeking help, such as the ready availability of toxic pesticides and the widespread,although erroneous, belief that suicide is illegal. Various interventions have been undertaken atdifferent levels in prevention and rehabilitation but a specific long-term national strategy for suicideprevention is lacking. Hence, to address this significant public health problem, a multisectoral platformof stakeholders needs to be established under government leadership, to design and implementinnovative and country-contextualized policies and programmes. A bottom-up approach, with activeand participatory community engagement from the start of the policy- and strategy-formulation stage,through to the design and implementation of interventions, could potentially build grass-roots publicownership, reduce stigma and ensure a scaleable and sustainable response.